on November 25th, 2014 No Comments
The prevalence of type 2 diabetes is expected to rise sharply over the next three decades. Recent data from the Centers for Disease Control and Prevention shows that if current trends continue, an estimated 1 in 3 adults will be diagnosed with the disorder by 2050. Eating healthy is a key component of managing diabetes and reducing one’s risk for developing the disease. But what does eating right for diabetes actually mean?
Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will answer this question during a talk focused on diabetes and nutrition on Dec. 4. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus, where attendees can also have their blood glucose checked. The conversation will also be webcasted for those unable to attend in person.
To promote discussion on the topic in advance of the lecture, I reached out to Kenny and asked about nutrition principles and guidelines for patients with diabetes and others interested in how healthy eating can prevent or delay onset of the disease. In the first installment of a two-part Q&A, she explains the advantages of eating a Mediterranean diet and the importance of eating fiber-rich foods.
Are there any ways to reverse or slow the progression of pre-diabetes? Are there specific diets that may be useful to help prevent or control diabetes?
One of the most common questions my diabetic patients ask is how they can reduce or eliminate diabetes medications. Others are found to be pre-diabetic on the basis of an “A1c” or an impaired fasting glucose, and want to know how to prevent diabetes. Several randomized trials have shown that healthy diet and exercise can reverse and also delay the onset of diabetes.
One of the largest trials is the often-cited Diabetes Prevention Program, which randomized more than 3,000 patients to diet/lifestyle versus metformin versus placebo. The most effective strategy was diet and lifestyle, showing a dramatic 58 precent reduction in the rate of developing diabetes. This surpassed the drug therapy with metformin. Approximately 5 percent of patients in the lifestyle group developed diabetes annually, as compared to 11 percent in the placebo arm. Notably, there was a 16 percent reduction in diabetes risk with every 1 kg reduction in weight. This seems attainable for many patients.
There was also meta-analysis last year looking at different diets for patients with known diabetes, in terms of weight loss and improving their diabetes control. In this data compilation, the Mediterranean diet had the greatest weight loss, followed by the low carbohydrate diet. In terms of A1c reduction, the Mediterranean diet had a reduction of -0.47 percent, and the low carbohydrate -0.12 percent. But all the diets studied resulted in better glycemic control. Many studies have shown that diets high in glycemic load are linked to higher diabetes risk (particularly in overweight women), and contribute to central body fat , so it is recommended that diabetics or those at risk limit their intake of high glycemic index foods both to delay and to help control their diabetes. Additionally, there are some data suggesting that adherence and success rate may be higher for low-carbohydrate diets in patients with diabetes and insulin resistance.